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La Transformatione' » Head & Neck » Rhinoplasty (Nose Job)


Rhinoplasty Surgery & Nose Surgery in Mumbai

Rhinoplasty better known as NOSE JOB surgery is the best way to reshape nose. Rhinoplasty can be done for functional reasons like difficulty in breathing or aesthetic reasons like a crooked nose. Rhinoplasty is broadly categorised into Closed Rhinoplasty and Open Rhinoplasty. In the closed Rhinoplasty procedure, the incision is inside the nostril. For Some deformities, open rhinoplasty is done where the incision mark is present in the undersurface of the nose (columella).

In Mumbai, Rhinoplasty is a very common procedure and at La Transformatione we have had experience in treating various kinds of nose deformity right from subtle deformity to crooked and deformed nose. The approach to a patient of rhinoplasty is very personal and very often it is a very subtle deformity which troubles the patient. The process starts with a detailed consultation about the concern of the patient. Any history of previous surgery of the nose or elsewhere is elicited. Also elicited is the history of any nasal bleed in the past, any breathing difficulty, any trauma to the nose, any allergies resulting in frequent sneezing , any medication causing blood thinning like Vitamin E, Aspirin etc. Any significant past history regarding any illness, diabetes, hypertension etc. is noted in detail.

Patient is asked to point out the deformity to be corrected in the mirror and on the photograph. Many a times it is found that the deformity is more prominent in the camera than in person and it is this which needs to be addressed.

A detailed examination and photography is done. The photography for nose is quite standard and consists of photograph from the front, both sides, chin up position( from the down) and both oblique views. The examination consists of external and internal nasal examination to see the external and internal deformities.

Usually a CT scan of the nose is ordered to look at the sinuses to look for any sinusitis and the nasal septum for any significant deviation.

After a detailed examination, the treatment plan is made. The deformity may be very subtle or quite big. The areas of concern are identified. It may be in the Tip, which can be broad, boxy, drooping, globular and so on. The nostrils may be bigger or smaller and the base (ala) may be broader. There may be deformity of the bridge of the nose which may be irregular, crooked, humpy, depressed and so on, the root of the nose similarly may be high or low. The nasal bones may be broad which may be of a concern, In severe cases, like in trauma, all the areas may be affected. In congenital deformities due to cleft lip, the nose is affected almost always and is less developed than the other side.

It is very important to see the whole face alongside the nose. Very often there are other abnormalities which may be found and also requires correction.

Once the problem is identified and a consensus is reached as to what all corrections need to be done, the treatment plan is made by the surgeon.

Both closed as well as open approach have their own pros and cons. The incision in closed rhinoplasty is hidden inside the nostril but the limitation of closed rhinoplasty is that it offers limited view and access to the nose. So all the areas of the nose cannot be accessed and all types of corrections cannot be done through small limited incisions. Usually Tip deformities, columella deformities, septal deformities, Hump reduction and Augmentation rhinoplasty with Silicone implants can be done through closed rhinoplasty. For other deformity corrections, Open Rhinoplasty approach is preferred.

The materials used for Nasal Augmentation are many and can be classified as Implants which are made up of Silicone or some other materials similar to Silicone. The other set of materials are Autogenous or from your own body. These materials are BONE or CARTILAGE. There are various plus and Minus of using each one of them and these should be discussed in great details with the surgeon. The Source of Bone is usually the Hip bone. Cartilage can be harvested from either the Nasal septum, Both ear cartilage or sometimes if more cartilage is required cartilage from the ribs may also be taken. Again there are various methods of putting the cartilage with each technique having its own benefit. It is in the best interest of the patient to be aware of these aspects and discuss in detail.

The nasal bone broadness requires, breaking (osteotomy) of the nasal bone and moulding of the nasal bone.

Broadness of the base of the nose (Ala) usually corrects itself by augmentation of the nasal tip. If Augmentation of the tip is not required, Alar reduction procedures are required.

In the post-operative period, usually the nostrils are packed for 24 to 48 hours and a nasal plaster/ splint is given. After the nasal packs are removed, some nasal drops are advised for a few days. Nasal plaster is kept for about 7 to 14 days depending on the surgery.

Nasal surgery swelling may not be restricted to the nose and may spread to the eyes and face in the initial few days. There is no need to be disturbed by that. The result of Rhinoplasty usually are visible after 2 weeks or so. But to get the final result it may take a couple of months. Even after that, there is some improvement over next few months. During the recovery time, usually gentle massage is advised to reduce the swelling and to hasten the recovery.

Nose defines the face and that is why rhinoplasty or nose job becomes an important issue for the patient where the patients expect absolute perfection. Perfection is alright, but when it becomes an obsession, the imagination spreads its wings leading to magnification of a minor residual problem. So it is better to have realistic expectation after rhinoplasty and also be patient till the swelling subsides. Magnification of a small problem may lead to depression which further adds to the problem and adds to the anxiety. One should realise that any surgery and every body part has limitations of some kind or the other. There may be structural limitation or the limitation may be due to different reaction of body to the surgical insult. Some people heal fast, some slow. Some are more prone to infection, some are less. In some people swelling subsides faster, in some it takes more time. Once we understand these limitations we will be more confident of undergoing a procedure. Your doctor is the best judge of the situation and is your best advisor at that point of time.

Another very important aspect is that people are often impressed by somebody else’s nose and want a nose like them. These are best as guidelines and the result of each person depends on his/ her skin, bone and other tissue which can be manipulated to an extent only. None the less these changes if done after proper thought process are often rewarding.

Rhinoplasty may be an Outpatient Surgery if a minor correction is required. Usually a stay for a day or two is suggested as the nostrils are packed and the packs have to be removed.

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Rhinoplasty

Side Effects of Rhinoplasty?
Generally Rhinoplasty is very well tolerated. But Rhinoplasty can have side effects sometimes. Bruising, tenderness and swelling are the usual side effects of this procedure. These settle fast. The uncommon side effect may be persistent nasal bleeding, recurrence of deformity, incomplete correction, septal perforation etc.

Durability of Result of Rhinoplasty Results of this procedure are permanent. It is important that as in any cosmetic surgery, the expectation from a rhinoplasty should be realistic. If augmentation of Nose has been done, depending on the type of material used for augmentation, changes may happen over the time. Such changes may be related to implant failure, bone resorption, cartilage’s long term deformity etc.

Recover from Rhinoplasty A splint / plaster is applied to the nose for about 1 -2 weeks. Bruising and swelling settles down in approximately 2- 4 weeks time. You will start to appreciate the results in 3 months time but the final results take up to about a year.

Insurance and Rhinoplasty. Insurance can cover your rhinoplasty surgery if it is associated with any functional disorders like breathing difficulty, deviation of the nasal septum, etc. It is best to clarify beforehand with all the documents related to the prior events which have led to such complications which require rhinoplasty.

Pain & discomfort after Rhinoplasty Like any other surgery, there will be some pain or discomfort but it can be minimised and taken care of by doctor prescribed medications. Usually there is swelling around the nose and eyes which settle in a few days.

Anaesthesia for Rhinoplasty Usually general anaesthesia is used, though in less severe cases, local anaesthesia along with sedation can be opted for.

Surgeries that can be done with Rhinoplasty Rhinoplasty is a fine surgery and requires due importance. It can be combined with Sinus surgeries if associated sinus problem is there. It is best not to combine rhinoplasty with any other surgery but if necessary rhinoplasty can be combined along with: Chin Augmentation, Blepharoplasty, Cheek Implants, Cheek/Mid-Face Lift etc.

WORDS OF WISDOM : Though Nose can make or break your face, it is important to be relaxed in the post-operative period. The results take time when the swelling subsides. Sometimes massage is advised to help get the shape. So patience is the key. It is also important to keep a realistic expectation and not to be expecting a particular celebrity’s nose because there are limitations of structure and procedure both. Please understand from the doctor what best results can be given to your nose.

PROCESS BEFORE SURGERY
1. 1st Consultation : Get a detailed consultation. Clarify all your doubts. Read about the process a bit (not too much!) and discuss in detail. Make sure that you have some if not all the idea as to what exactly are you looking for. Tell the doctor about any previous surgery or illness or any sort of allergies.
2. Repeat Consultation : Go back after the first consultation and think. Make a list of things to clarify and understand and meet the doctor or the team again.
3. Expectation of results : Please be doubly sure as to what result you are expecting and you and your doctors are at sync and on the same page. This will make things easy for you in the post-operative period. It is better to have realistic expectations as there are various limitations of your body as well as of the surgery.
4. Measurements: Many a times some measurements are required. Ask if any measurement of your body or for pressure garment etc. is required.
5. Investigations : Most surgeries require some investigations and these must be done at a good laboratory. It is in your best interest that you get the investigations done as advised because the decision to do the surgery will depend on them.
6. Understanding the Plan : Plastic surgery is an innovative branch of surgery where meticulous planning is very important. Both the patient and the doctor must be at comfort with the plan. It may take a couple of consultations for the best plan to be finalised for a complicated surgery.
7. Finalise the hospital.
8. Schedule the date of surgery and advance payment or full payment : Please make sure that the full procedure of payment is understood by you and there are no hidden costs. If there are some over heads, you should have an idea regarding them. Also note that some services of Cosmetic surgeries are taxable by the Government and you may have to pay extra for them.
9. Understand the preoperative instructions well like being empty stomach before surgery, shaving etc.
10. Photography : Pre-operative and post-operative photography helps in judging the results objectively and is helpful for you as well as the doctors and also removes the scope of ambiguity.
11. Report for surgery on time or a little before that so that you are relaxed. ( better if accompanied by an attendant).


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